The American Medical Association's 2025 Physician Practice Benchmark Report contains a number that should be at the center of every healthcare vendor's contact data strategy, and largely is not: the share of physicians working in physician-owned private practice fell to 42.2 percent in 2024, down from 60.1 percent in 2012. In 12 years, independent physician practice went from the dominant mode of physician professional life to a minority position — an 18-percentage-point structural shift that has completely rewritten who signs contracts, approves vendor relationships, and controls purchasing budgets across the healthcare technology, medical device, pharmaceutical, and staffing markets.
The consolidation has moved in multiple directions simultaneously. According to the GAO's September 2025 analysis, at least 47 percent of physicians were employed by or affiliated with hospital systems in 2024, up from less than 30 percent in 2012. Private equity ownership of physician practices represents approximately 6.5 percent of physicians nationally but exceeds 30 percent in gastroenterology, dermatology, and ophthalmology. UnitedHealth Group's Optum division alone affiliates with roughly 90,000 physicians nationwide. Private equity remains the dominant buyer in physician practice M&A in 2026, representing more than 90 percent of transactions, with EBITDA multiples in high-demand specialties still reaching into the double digits. All 10 of the largest U.S. insurers have acquired physician practices or management services organizations.
The practical consequence for healthcare vendors is stark: the physicians who used to make or substantially influence purchasing decisions — the independent practice partners who controlled their own formularies, selected their own equipment vendors, and managed their own EHR relationships — now make those decisions at a rate less than half of what they did 12 years ago. The purchasing authority that used to reside with individual physicians or small practice partnerships has migrated to hospital system administrators, private equity portfolio management teams, group practice medical directors, and the Management Services Organization leadership that now handles vendor contracting for affiliated practices that technically retain clinical independence. Most physician mailing lists and healthcare email lists were not built to reflect this migration.
The AMA president's statement accompanying the 2025 benchmark report was unambiguous about the direction of travel: the cumulative impact of burdensome regulations, rising financial strain, and relentless cuts in payment poses a dire threat to the sustainability of private practices. Medicare physician payment has fallen 33 percent in real terms over the past quarter century after adjusting for inflation in practice costs. These structural pressures are not reversing, and the consolidation trend they are driving is not pausing.
Hospital-employed physicians represent the largest and most established consolidation segment. At least 47 percent of physicians were employed by or affiliated with hospital systems in 2024. These physicians operate within hospital procurement frameworks — with technology and vendor decisions made by system-level CMOs, CIOs, and supply chain executives — rather than independently. Pharmaceutical representatives who have been detailing to the same physician for a decade may not realize that the physician's ability to make independent formulary decisions was eliminated when their practice was acquired by the local health system three years ago.
Private equity-backed physician practices represent a smaller but rapidly growing and strategically distinct consolidation segment. The PE-backed practice model typically involves a centralized Management Services Organization handling all non-clinical operations — including vendor contracting, technology procurement, and supply chain — while physicians retain clinical autonomy. The vendor purchasing authority in this model resides with MSO leadership and PE portfolio management teams, not with the individual physicians who appear as the primary contacts in most physician mailing lists.
The independent practice segment — now 42.2 percent and declining — is also changing internally. The Medical Economics panel discussion from November 2025 documented that PE golden parachute buyout premiums have declined significantly, motivating some practices to remain independent while exploring MSO affiliation as a middle path. Independent practices that remain are increasingly using shared back-office infrastructure, group purchasing organizations, and MSO services to manage administrative burden — partially centralizing some purchasing decisions while preserving clinical independence. Even the physician who appears in a doctor mailing list as an independent practitioner may have outsourced their vendor contracting to a shared services organization.
• Pharmaceutical representatives. Pharmaceutical representatives maintaining physician-level contact databases for detailing, formulary access, and relationship management are working with data that dramatically overstates the purchasing influence of individual physicians at hospital-employed and PE-backed practices. A physician who appears in a doctor mailing list as a primary detailing contact may be practicing under a hospital formulary that eliminates individual prescribing discretion for the products being promoted. Segmenting physician outreach by employment status — independent versus hospital-employed versus PE-affiliated — is the foundational accuracy requirement that most pharmaceutical physician mailing lists do not meet.
• Medical device and equipment vendors. Medical device and equipment vendors who have historically sold to practice-level purchasing contacts are finding that the hospital system or MSO that now controls procurement is running consolidated purchasing processes with standardized contracts, volume pricing, and vendor rationalization programs that individual physician preferences have limited ability to influence. Reaching the system-level supply chain and CMO contacts who actually control device vendor relationships requires healthcare mailing lists that map above the physician level to the administrative infrastructure of consolidated healthcare systems.
• Healthcare technology vendors. Healthcare technology vendors — EHR systems, population health platforms, telehealth infrastructure, clinical decision support tools — have always sold primarily at the system level, but the consolidation wave has made the system-level buyer even more consequential as the total number of independent purchasing units shrinks and the scale of consolidated system contracts grows. Vendors who have not updated their healthcare contact databases to reflect the organizational structure of major consolidated systems are presenting to the wrong contact at the wrong organizational level.
• Healthcare staffing and physician recruitment firms. Healthcare staffing firms and physician recruitment organizations are navigating a market where the employment status of the candidate matters as much as their clinical specialty. Physicians considering leaving hospital employment to join or start an independent practice — a trend the Medical Economics panel discussed as a renewed possibility as PE buyout premiums have declined — represent a distinct and high-value recruitment audience that most physician mailing lists do not identify as a separate targeting segment.
• Chief Medical Officer at consolidated hospital systems. The central purchasing authority for clinical technology, medical equipment, and pharmaceutical formulary at hospital-employed physician practices. Hospital CMOs in consolidated systems control vendor relationships affecting potentially hundreds of affiliated physicians simultaneously — a concentration of purchasing authority that makes the CMO contact more valuable per outreach interaction than any number of individual physician contacts in practices that have lost independent purchasing authority. Most physician mailing lists underweight this contact relative to its actual purchasing significance.
• MSO Medical Director and MSO Administrative Leadership. The equivalent of the CMO at MSO-structured private equity physician platforms. MSO Medical Directors hold clinical oversight authority over affiliated practices while MSO administrative leadership controls vendor contracting, technology selection, and supply chain management. Reaching both the clinical and administrative leadership of MSO-structured physician platforms requires healthcare mailing lists that map the MSO organizational structure explicitly.
• Group Practice Medical Director. Group practice Medical Directors at physician-owned multispecialty groups of meaningful scale represent the remaining segment of concentrated physician purchasing authority outside hospital and PE structures. Groups like New York Cancer and Blood Specialists — 300 physicians, 52 new hires in a single year, remaining private — represent purchasing conversations that aggregate many physician preferences into a single contract relationship. Most physician mailing lists include individual physician members of large groups without identifying the group practice Medical Director who actually controls vendor relationships.
• Director of Supply Chain / Value Analysis Committee Chair. Supply chain and value analysis committee leadership at consolidated hospital systems and large physician groups are the operational counterparts to clinical leadership in technology and equipment purchasing. The CMO approves vendor categories strategically; the supply chain director executes the contracts. Healthcare mailing lists that reach clinical leadership without operational supply chain contacts are mapping half of the buying committee for technology and equipment vendor categories.
• Independent physician practitioners. Independent physicians in the remaining 42.2 percent of independent practices retain meaningful purchasing authority and remain essential contacts for vendor categories where individual physician preference still drives decisions. But they should be identified as independent practitioners in physician contact databases rather than assumed to hold purchasing authority that many consolidated colleagues no longer have.
• Employment status as the foundational segmentation variable. Employment status is the most fundamental accuracy requirement for physician mailing lists in 2026. A physician contact database that does not distinguish between independent practitioners, hospital-employed physicians, and PE-affiliated physicians is systematically misrouting outreach for any vendor category where purchasing authority depends on employment structure. This segmentation variable should be the first filter applied before any specialty, geography, or title-based targeting.
• MSO identification for PE-affiliated physician practice networks. MSO identification is the emerging segmentation requirement for vendors targeting the PE-backed physician practice market. As MSO-affiliated practice networks span dozens or hundreds of physician practices under a single administrative vendor contracting structure, reaching the MSO leadership rather than individual affiliated physicians is the difference between one outreach contact with meaningful purchasing authority and hundreds of outreach contacts with limited individual purchasing influence.
• M&A transaction tracking as a purchasing intent signal. Acquisition transaction tracking provides a purchasing intent signal that most physician mailing lists do not incorporate. Physician practices that have recently been acquired — within 6-18 months of the transaction — are in a post-acquisition integration phase during which legacy vendor relationships are being reviewed, standardized, and often terminated. This represents a specific window of vendor evaluation receptivity visible through M&A transaction data before it is visible through physician contact behavior.
• Cross-sector integration with government public health contacts. Organizations targeting consolidated health systems alongside government public health agencies benefit from integrating physician mailing lists with government contact data from Civic Data. Health system executives operate at the intersection of clinical delivery and public health governance in ways that make their purchasing decisions relevant to both healthcare vendors and government health program administrators.
• Higher response rates from physician mailing lists and healthcare email lists because outreach reaches current purchasing authorities — hospital CMOs, MSO Medical Directors, and group practice Medical Directors who hold system-level vendor contracting authority — rather than individual physician contacts who no longer hold the purchasing influence they once did at the practice level
• More efficient pharmaceutical detailing outreach because physician contact databases segmented by employment status identify which physicians retain meaningful formulary influence versus those operating under hospital or MSO formularies that limit individual prescribing discretion
• Better conversion from healthcare technology evaluations because outreach reaches both the clinical CMO and supply chain Director who together constitute the complete buying committee for most technology and equipment vendor categories at consolidated health systems
• Reduced campaign waste because physician contacts at practices recently acquired — in post-acquisition vendor rationalization mode — are identified and timed for outreach at the right point in their post-acquisition buying cycle
• Stronger cross-sector outreach performance for organizations managing physician, government, and education workforce contacts simultaneously through Physician Data, Civic Data, and K12 Data platforms
For organizations recruiting employed physician leadership, MSO management professionals, and healthcare system administrators, Peertopia — the K-20 and government jobs platform — provides adjacent workforce marketplace infrastructure for the healthcare administrative roles that the consolidation wave is creating across the country.
• Independent physician practice will continue declining toward 40 percent. The share of physicians in hospital or corporate-employed practice will continue growing, with AMA projections suggesting independent practice could fall below 40 percent by 2028. Each percentage point of consolidation reduces the number of independent purchasing units in the physician market and increases the relative purchasing authority of system-level CMOs and MSO administrators — making the organizational buyer map increasingly distinct from the individual physician contact databases most pharmaceutical and device companies maintain.
• PE divestiture will create vendor relationship transition opportunities. Private equity divestiture from some over-leveraged physician practice platforms will create a transitional period in which practices are being resold, restructured, or returned to independent management. Vendor relationships established during PE ownership may be renegotiated or terminated, and the contacts holding purchasing authority during the transition may change multiple times within a 12-18 month window.
• MSO expansion into new specialties will continue reshaping the purchasing map. Management Services Organization expansion into new specialty markets will continue driving consolidation in dermatology, ophthalmology, gastroenterology, and behavioral health. Healthcare mailing lists and doctor mailing lists that track MSO expansion by specialty are better positioned to identify high-consolidation-risk practices before the transition changes their purchasing structure.
• Prior authorization reform could slow consolidation in primary care. Prior authorization reform advancing in Congress could reduce administrative burden at both independent and employed physician practices in ways that affect the financial calculus of practice independence. Reduced administrative burden is one of the factors that makes hospital employment attractive; meaningful prior authorization relief could slow the consolidation trend in primary care specialties most affected by this administrative load.
The physician consolidation wave is the most significant structural change in the healthcare vendor buyer map since the ACA-era Medicaid expansion. The shift from 60 percent independent practice in 2012 to 42.2 percent today represents an 18-percentage-point migration of physician purchasing authority from individual practitioners to hospital system CMOs, MSO administrators, and PE portfolio management teams — a migration that most physician mailing lists and healthcare email lists have not tracked.
Healthcare technology vendors, pharmaceutical representatives, medical device companies, and staffing firms that build physician contact databases and healthcare mailing lists reflecting the 2026 consolidated reality — employment status segmentation, MSO identification, system-level CMO contacts, and supply chain administrator targeting — will find that the consolidation wave has not made the healthcare market harder to sell into. It has concentrated purchasing authority in a smaller number of organizational buyers with larger contract values and more durable vendor relationships. The competitive advantage belongs to the vendors whose contact data can find those buyers.
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